title: Ovarian hyperstimulation syndrome prevention by gonadotropin-releasing hormone agonist triggering of final oocyte maturation in a gonadotropin-releasing hormone antagonist protocol in combination with a "freeze-all" strategy: a prospective multicentric study.
abstract: OBJECTIVE
  To prospectively study ovarian hyperstimulation syndrome (OHSS) incidence and cumulative live birth rate in a cohort of patients at risk of OHSS undergoing ovarian stimulation in a GnRH antagonist protocol and receiving a GnRH agonist triggering followed by cryopreservation of all two pronuclei (2PN)-stage zygotes by two methods, vitrification or slow-cooling, for later ET.
  
  
  METHODS
  Prospective, clinical cohort study.
  
  
  METHODS
  Five IVF centers in Germany; time frame: June 2008 to June 2010.
  
  
  METHODS
  Fifty-one female patients undergoing IVF considered at risk of developing severe OHSS (≥20 follicles≥11 mm and/or E2 level≥4,000 pg/mL) after ovarian stimulation in a GnRH antagonist protocol.
  
  
  METHODS
  Triptorelin (0.2 mg SC) for triggering final oocyte maturation. All 2PN-stage zygotes were cryopreserved by vitrification or slow-cooling for later repetitive frozen-thawed ET.
  
  
  METHODS
  Severe OHSS incidence and cumulative live birth rate per patient.
  
  
  RESULTS
  Of 51 patients, 1 patient (2%, 95% confidence [CI] 0.3%-10.3%) had zero oocyte retrieved, 1 patient did not undergo frozen-thawed ET, and 1 patient had no surviving oocyte after thawing. Thus, 48 patients underwent at least one frozen-thawed ET. The cumulative live birth rate was 37.3% (19/51, 95% CI 25.3%-51.0%). The live birth rate per first frozen-thawed ET was 5.9% (1/17, 95% CI 10.0%-27.0%) and 19.4% (6/31, 95% CI 9.2%-36.3%) in the slow-cooling and vitrification group, respectively (difference: 13.5%, 95% CI of the difference: -9.9%-31.1%). Three cases of OHSS II (3/51, 5.9%, 95% CI 2.0%-15.9%) and one early-onset case of OHSS III (1/51, 2%, 95% CI 0.3%-10.3%) occurred.
  
  
  CONCLUSIONS
  Agonist triggering with cryopreservation is efficacious and safe, although a single case of a severe early-onset OHSS occurred.
authors.affiliation: Department of Obstetrics and Gynecology, University Clinic of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany. griesing@uni-luebeck.de
authors.forename: Georg
authors.initials: G
authors.lastname: Griesinger
authors.forename: Laura
authors.initials: L
authors.lastname: Schultz
authors.forename: Thomas
authors.initials: T
authors.lastname: Bauer
authors.forename: Anke
authors.initials: A
authors.lastname: Broessner
authors.forename: Thorsten
authors.initials: T
authors.lastname: Frambach
authors.forename: Stefan
authors.initials: S
authors.lastname: Kissler
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D005615:Freezing; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000037:antagonists & inhibitors; D006727:Hormone Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D054315:Oocyte Retrieval / Q000379:methods*; D009865:Oocytes / Q000187:drug effects / Q000502:physiology; D009866:Oogenesis / Q000187:drug effects; D016471:Ovarian Hyperstimulation Syndrome / Q000517:prevention & control*; D010062:Ovulation Induction / Q000379:methods; D011247:Pregnancy; D018873:Pregnancy Rate; D017329:Triptorelin Pamoate / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D006727:Hormone Antagonists; D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone